Benefits of Therapeutic Massage Therapy

Massage Therapy and Chiropractic

By Lori A. Burkhart

At the Florida Chiropractic Association (FCA) annual convention in August 2013, the Florida State Massage Therapy Association (FSMTA) had a strong presence, in order to provide greater awareness, exposure and education to attendees about the benefits of massage therapy. FSMTA believes it is important to build strong relationships as it looks to the future of heath care.

Indeed, chiropractic practices often offer massage therapy as part of their services, and if you are considering doing the same, Jay Greenstein, DC, who owns seven practices in Maryland, has insight into the relationship between doctors of chiropractic and massage therapists. When he started, his small operation of himself and a front desk person did not offer any extra services. But when he expanded and had more room, massage therapy services were added.Business Decisions and Wellness
According to Dr. Greenstein, the decision was made to add massage therapy to the practice because it added another skill set helpful for patient care. “We have our soft-tissue techniques, Graston Technique, myofascial release and all of our other rehab that we do, but sometimes patients just require more one-on-one attention as it relates to deep-tissue work,” he says. Dr. Greenstein explains that often patients require more than 15 or 20 minutes of soft-tissue work, even up to an hour or multiple sessions of an hour.“Purely from ‘hey what else is it going to take to get this patient well?’ That was really the main decision point,” Dr. Greenstein says, about adding massage therapy to the practices. But he notes that some people simply like massage for wellness and often combine it with their maintenance adjustment.

“Because soft tissue is an important component of improving musculoskeletal health, to the degree again that a patient requires more time and more focused attention getting that work done is when they get referred to the massage therapist,” says Dr. Greenstein. “I think that just the mental side of it, the relaxation part of it, the person who is working 60 to 70 hours a week deserves an hour of time dedicated to something that feels good. Even that can have a positive physiological impact on a patient’s overall health. Some of it is tied directly to musculoskeletal health, and some of it is tied to stress management.”

Therapeutic Benefits
While massage therapy has a history reaching back thousands of years, scientific evidence on its benefits is limited, but studies are in progress, and that is changing. The National Institutes of Health’s (NIH) National Center for Complementary and Alternative Medicine (NCCAM) says that scientific research on massage therapy provides evidence that massage may benefit some patients. Effects on specific health conditions are being studied.

Yet massage therapy certainly makes people feel better, and there is huge patient demand for it. With that in mind, NCCAM has been funding studies into the effects of massage:

  • On chronic neck pain and low-back pain;
  • To treat anxiety disorder, alleviate depression in patients with advanced AIDS, and promote recovery in women who were victims of sexual abuse as children;
  • To relieve fatigue in cancer patients undergoing chemotherapy, reduce treatment-related swelling of the arms in breast cancer patients, and alleviate pain and distress in cancer patients at the end of life;
  • On weight gain and immune system function in preterm infants; and
  • On whether massage given at home by a trained family member helps reduce pain from sickle cell anemia.
For example, a recent study found that a 60-minute session of Swedish massage therapy delivered once a week for pain due to osteoarthritis of the knee was both optimal and practical, establishing a standard for use in future research.1 This trial, funded by NCCAM and published in the journal PLoS One, builds on an earlier pilot study of massage for knee osteoarthritis pain, which had promising results but provided no data to determine whether the massage dose was optimal.
Another NCCAM-funded study found massage therapy helped reduce pain and improve function more rapidly than usual medical care in people with chronic low-back pain. The researchers point out that the mechanisms by which massage helped in this study remain unclear — benefits could come from specific local effects on the body, or from non-specific effects such as a relaxing environment, being touched or increased body awareness. The study provides additional evidence that, as the researchers conclude, massage therapy can be a helpful adjunct in treating chronic low-back pain.2Research also indicates that massage therapy can improve mood and reduce depression.3In addition, recent studies suggest massage may benefit certain conditions. A systematic review published in 2009, assessing the effects of massage therapy for nonspecified low-back pain, looked at 13 clinical trials and found that massage might be beneficial for patients with subacute and chronic nonspecific low-back pain, especially when combined with exercise and education.4

Another study shows it is feasible to provide therapeutic massage at home for patients with advanced cancer, and to randomize patients to a no-touch intervention. Providing therapeutic massage improves the quality of life at the end of life for patients and may be associated with further beneficial effects, such as improvement in pain and sleep quality. Larger randomized controlled trials are needed to substantiate the findings.5

Hiring a Massage Therapist
While the evidence for massage therapy is growing, the demand for such services is great. In hiring and retaining good employees, finding massage therapists can create a unique challenge for the chiropractic business owner. It’s a different type of challenge based on the desires and goals of the massage therapist; do they mesh and coincide with the goals and desires of the DC? According to Dr. Greenstein, “Finding a massage therapist who is really clinically oriented and wanting to learn and be a part of the clinical care of the patient, may not be the same kind of goal and desire of the massage therapist who perhaps is a little more esoteric in his or her approach.”

He recommends that practitioners seek out local massage therapy schools in their area and become guest lecturers, because this will help them develop relationships with people who know the students and perhaps will send good graduating students their way. That can be a useful method of finding a massage therapist who will be a proper fit with your practice.

“The interviewing and hiring process is really important to make sure, like every other employee you hire, that those are people who align with your values,” Dr. Greenstein explains. “Don’t say something you think the massage therapist wants to hear because you need one in your practice. To get the right person, be real about what you want and expect, his or her service delivery, clinical outcomes and then the likelihood of your having a long-lasting relationship will be significantly greater.”


1. Perlman AI, Ali A, Njike VY, et al. Massage therapy for osteoarthritis of the knee: a randomized dose-finding trial. PLoS One. 2012; 7(2):e30248.

2. Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types of massage and usual care on chronic low-back pain: a randomized, controlled trial. Annals of Internal Medicine. 2011; 155(1):1–9.

3. Hou WH, Chiang PT, Hsu TY, Chiu SY, Yen YC. Treatment effects of massage therapy in depressed people: a meta-analysis. J Clin Psychiatry. 2010; 71(7):894-901.

4. Furlan AD, Imamura M, Dryden T, Irvin E. Massage for Low Back Pain. Spine. Jul 2009, Vol. 34, No. 16: 1669-1684.

5. Toth M, Marcantonio ER, Davis RB, Walton T, Kahn JR, Phillips RS. Massage Therapy for Patients with Metastatic Cancer: A Pilot Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine. July 2013: 650-656.

ACA News Extra…
Massage at the Biological Level
Massage is used for many health purposes, but NCCAM partly funded a study on its effects on a biological level as little is known about it. Preliminary data led researchers to conclude that a single session of Swedish massage produces measurable biological effects and may affect the immune system. However, more research is needed to determine the specific mechanisms and pathways behind these changes.Rapaport MH, Schettler P, Bresee C. A preliminary study of the effects of a single session of Swedish massage on hypothalamic-pituitary-adrenal and immune function in normal individuals. The Journal of Alternative and Complementary Medicine. 2010; 16(10):1–10.
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